S1E26: Indigenous Peoples / Rebecca Nagle, Melissa Begay, Jamescita Peshlakai

“I think there’s always sort of like Indian humor with everything and so there were a lot of people making jokes about Trump putting a travel ban in place to stop the spread of disease from Europe. A lot of Native people on Twitter and Facebook were commenting that it was, you know, a few centuries too late.” -Rebecca Nagle

In this episode, our host Dr. Celine Gounder speaks to Rebecca Nagle, Dr. Melissa Begay, and Jamescita Peshlakai about why the Navajo Nation has been so hard hit by COVID, and what their communities are doing to protect everyone—young and old—during this pandemic. The Navajo Nation is the nation’s largest indigenous tribe and has the highest per capita infection rate of COVID in the United States.

Dr. Melissa Begay is a member of the Navajo Nation, and a physician at the University of New Mexico in the Department of Pulmonary, Sleep and Critical Care. Jamescita Peshlakai is an Arizona State Representative and represents eight tribes in her district, including the Navajo. Rebecca Nagle is an Indigenous rights activist, writer and speaker, and a citizen of the Cherokee Nation. She also hosts the Crooked Media podcast, “This Land,” about a Supreme Court case on the land rights of indigenous peoples in Oklahoma.

This podcast was created by Just Human Productions. We’re powered and distributed by Simplecast. We’re supported, in part, by listeners like you.

Celine Gounder: Melissa Begay is a doctor living in Albuquerque, New Mexico.

Melissa Begay: I’m Melissa Begay and I am a physician at UNM in the Department of Pulmonary, Sleep and Critical Care.

Celine Gounder: But back where Melissa grew up… near Canyon de Chelly, Arizona… she’d probably introduce herself this way instead…

Melissa Begay: Dine intro

Celine Gounder: Melissa is a member of the Navajo Nation, the nation’s largest indigenous tribe. The Navajo Nation’s lands are about the size of West Virginia and cover the Four Corners region where Arizona, Colorado, New Mexico, and Utah meet.

Melissa Begay: So I grew up on the North rim of Canyon de Chelly and in Navajo, it is called Navajo name. There are a lot of cultural teachings that happen there. A lot of traditional people still live in Canyon. In growing up there, you were definitely taught the importance of place, but then also the importance of, of history. For myself as a young person, um, it really taught me a lot about, um, our connection to land in our, um, my people’s connection to the seasons. So it was a great place to, to live in it and, and grow up as a young, as a young child.

Celine Gounder: And hand shakes are an important part of the Navajo greeting.

Melissa Begay: Navajo greeting is, is very important and it usually begins with a handshake to acknowledge your presence and their presence and then also you often say your clans. You often will teach your kids from a young age to shake hands when they’re toddlers, and then as they’re, uh, beginning to speak and go into kindergarten and they often are taught their four major clans so it’s important just to establish your lineage because it’s very old and people often identify Navajos by region and by clans. So, um, it often makes more sense, especially to the elders.

Celine Gounder: But the pandemic has made everyday gestures like handshakes dangerous… especially for the elders in Melissa’s community. See, the Navajo Nation has the highest per capita infection rate of COVID in the United States—even higher than New York City.

Nursing homes are one of the hotspots for coronavirus, and elderly Americans are among the most vulnerable for severe COVID infections. Losing anyone to COVID is tragic… but there’s even more on the line for the Navajo Nation and other indigenous peoples.

Melissa Begay: The elders are the keepers of traditional stories. They are the keepers of that traditional knowledge of herbs, ceremony, language history, and that is, uh, very important to us. If we lose these elders, we can lose hundreds of years of knowledge

And so, when you have the passing of these elders, it’s really, um, for Navajo people like losing an encyclopedia. It’s like losing libraries and museums.

Celine Gounder: In this episode of “Epidemic”, we’re going to find out why the Navajo Nation has been so hard hit by COVID, and what their communities are doing to protect everyone—young and old—during this pandemic.

I’m Dr. Celine Gounder, and this is “Epidemic.” Today is Friday, June 5th.

Melissa Begay: Canyon de Chelly is now a National Park. And so it is traditionally a very important spiritual place to the Navajo people because it houses a spire rock called Spider Rock. And that Spider Rock is the home of a Navajo deity called Spider Woman who, uh, assisted the Hero Twins on their journey when the Navajo were going through the various emergence worlds in Navajo religious philosophy.

Celine Gounder: You should really look up pictures of Spider Rock. It’s stunning. But besides the natural wonder of the rock formations in Canyon de Chelly, the area has another meaning for the Navajo. It’s a stronghold.

Melissa Begay: In 1864, when the Navajo people were imprisoned by the US army, they tried to get a lot of the Navajo people out of Canyon de Chelly to go on the Long Walk to Fort Sumner. And because of the rough terrain and the steep cliffs, they weren’t able to get a lot of those Navajo families out. And so, what happened is many of those Navajo families stayed and did not go to the Long Walk from 1864 to 1868 and remained in the Canyon. So, it’s kind of seen as a Navajo stronghold.

Celine Gounder: The Long Walk was akin to the Trail of Tears, which forcibly removed the Cherokee Nation from Georgia to Oklahoma. Many Navajo were interned at Fort Sumner, New Mexico for years.

Once at Fort Sumner, illness struck. The Navajo died from exposure to the elements… hunger… dysentery… pneumonia… tuberculosis… and smallpox. The prison-like living conditions contributed to the spread of disease. Many Navajo died. Native Americans have a long and devastating history with infectious diseases… especially those brought in from the outside world.

Jamescita Peshlaki: A lot of the oral history of the Navajo is handed down by our elders that remember these hard times. The way they speak about it is they say, ‘this is not the, the first time that this has happened.’

Celine Gounder: This is Arizona State Representative Jamescita Peshlaki.

Jamescita Peshlaki: I am Navajo or Dine, what we call ourselves, and my clans are Tangled People clan born for the Red House clan, maternal grandfathers, are Bitter Water clan and paternal grandfathers are Cliff Dweller clan.

Celine Gounder: Jamescita represents eight tribes in her district, including the Navajo. She says that the elders in her community still have strong oral histories about how disease during the time of internment and before influenced their culture today.

Jamescita Peshlaki: One of the cultural taboos about death, is the handling of the body, the corpse, and a traditional way to bury a person that has passed away is to first of all, when they’re ready to pass, you take them out of the home. And only one person is to prepare the body for burial and wrapped in a blanket and that person is the only one to touch the body, not the rest of the family. The traditional way they used to place the body was in the earth or amongst rocks and stones. And then the person was not to be mentioned again, or grieved for, or to go visit the grave or, um, touch the things of the person that passed. So those cultural traditions have become our way because disease has taken so many people in the past.

Celine Gounder: Those stories are also a source of strength. Melissa Begay says the traditional healers in her community tell stories about another big pandemic… the 1918 Spanish flu.

Melissa Begay: They talk about the time of a great sickness when a lot of Navajo people did pass away during the Spanish flu. Many communities had to abandon where they lived and families were basically decimated. But the stories that I heard growing up are ones of resilience and strength,

Rebecca Nagel: With colonization of our peoples came pandemics of infectious diseases like smallpox. For Cherokees it was in the 1700s, where we lost, you know, large chunks of our population. You know, I think there’s always sort of like Indian humor with everything and so there were a lot of people making jokes about, um, Trump putting a travel ban in place to stop the spread of disease from Europe. [laughs] A lot of Native people on Twitter and Facebook, uh, were commenting that it was, you know, a few centuries too late.

Celine Gounder: This is Rebecca Nagel. Rebecca is an indigenous rights activist, writer and speaker, and she’s a citizen of the Cherokee Nation. She’s also the host of her own podcast, “This Land.” It’s about a Supreme Court case on the land rights of indigenous peoples in Oklahoma.

Rebecca Nagel: But I don’t think we even have to go back that far to the era of Columbus to see that infectious diseases can have a disproportionate impact on indigenous communities.

Celine Gounder: The Navajo, Cherokee, and hundreds of other tribes ended up signing treaties with the United States as it expanded West. Native Americans agreed to sign over their land and end violent conflict, and in return the United States agreed to provide education, housing, and healthcare to the tribes. To provide health care on reservations, the federal government set up the Indian Health Service.

Rebecca Nagle: Indian Health Services actually predates both Medicare and Medicaid. It’s one of the oldest federal health programs. But it’s not an entitlement program. So, like if you are eligible for Medicare or Medicaid, it’s called an entitlement program because if you’re eligible, you’re entitled to that service. But IHS is funded through a discretionary budget. So instead of Congress looking at, all right, this is how many patients IHS has; This is how many tribal citizens will need to access healthcare; This is how many people qualify for this program, so this is how we’re going to fund it. The funding of IHS is up to congressional politics, budgeting and things like that.

Celine Gounder: The U.S. federal government hasn’t been meeting these obligations for a long time.

Rebecca Nagel: So tribal leaders recently said for Indian Health Services to be fully funded, needed $36.8 billion. Um, and for 2020, Congress appropriated about $6 billion. And so, you know Indian Health Services is funded at about 16% of its need.

And you know, sometimes people use phrases like, ‘Oh, well, Native Americans get free this or free that,’ or you know, I’ve seen some are reporting where people are talking about how Native Americans are supposed to have access to free healthcare. And I think it’s really important to emphasize that it’s not free, um, that we actually gave up, you know, billions of acres of land in exchange for these treaty obligations. That was land that had a high value at that time and continues to have a high value today.

I interviewed Representative Tom Cole for the article that I wrote for Vice, and he had a great quote where he said, “you know, I always tell people that if they want to not continue to meet these treaty obligations they can always just give us back northern Mississippi,” and he’s talking about the homelands of his tribe, the Chickasaw nation.

Celine Gounder: Rebecca points out that the economic shutdown that came with the pandemic has hit Native Americans living on reservations especially hard. Because tribes don’t have the right to levy property taxes, they have to use tribal businesses to raise money, to supplement the meager funds the federal government provides them for education and healthcare, and other services.

Rebecca Nagel: So in addition to money from treaty obligations from the federal government, a lot of tribes, we have our own businesses and our own enterprises, which are being dramatically hurt by this pandemic as well. I saw a report that all tribal casinos nationwide are closed right now, and so that revenue isn’t sort of just a loss of profit, like you would think of like an MGM resorts or something like that. That money goes into healthcare, education, housing for tribal citizens. So, there’s also going to be a long term need, um, to really help tribes sort of recover economically from this time to make sure that they’re still in a position to provide those services for tribal citizens.

Celine Gounder: And that’s not even taking into account unemployment. Representative Jamescita Peshlaki says on the Navajo Nation, unemployment was around 50% before the pandemic and the economic shutdown. With the loss of tourism and other service jobs, she estimates it could be as high as 90% today. Now, there was money set aside for the Indian Health Service in the third CARES Act.

Rebecca Nagel: The National Indian Health Board and other leading Native organizations were saying that Indian Health Services needed about $2.3 billion in funding to weather the pandemic and to save lives, and about a billion was in the third relief bill. And so, it’s a good step. It’s definitely a big win. But Congress definitely needs to do more.

Celine Gounder: Fighting for resources from Washington is hard enough. But Rebecca says the federal bureaucracy is its own hurdle when it comes to actually getting the money where it’s supposed to go.

Rebecca Nagel: The first coronavirus relief package had a $40 million set aside for tribes that was held up in bureaucratic limbo for weeks, because the CDC had no way to get that money from the CDC over to Indian health services.

You know, tribes have to constantly remind departments in Washington, how to work with us, how to partner with us, how to consult with tribes how to treat tribes like equals and like partners in government. And I think that sometimes because, um, you know, the federal government isn’t used to doing it, it’s not very good at it, and so I think, you know, this sort of hang-up with getting funds from that first relief package, I think is a really good example of how, you know, agencies like the CDC have just not been wired to work with tribes. And then when a crisis hits they see how incapable they are of doing that. Although they are making progress and moving forward.

Celine Gounder: On the Navajo Nation, Dr. Melissa Begay says that jurisdictions also complicate basic epidemiology, like tracking the spread of COVID.

Melissa Begay: Right now, what we’re, what the tribe is having difficulty with is contact tracing. So right now, they have a lot, but they only have about eighty contact tracers, and a lot of these tracers are finding difficulty in actually locating positive COVID patients out in the field because they don’t have a phone or an email address. And a lot of the Navajo houses actually don’t even have a physical mailing address. And so, when you have lack of correct contact information, it definitely makes their job a little bit more difficult.

Celine Gounder: Phone and email seem so essential to a lot of people that it’s hard to imagine life without them. But basic necessities and infrastructure are often lacking on Native American reservations.

So, this is a little complicated but please bear with me. Because the land is technically owned by a trust administered by the federal government and not the tribes, Native Americans have to go through reams of red tape to do some of the most basic things.

And on top of that, a land dispute in the 1960s between the Hopi and the Navajo resulted in a total ban on all development in the region. Electrical lines, water mains, even making basic improvements to your home wasn’t allowed. That ban is known as the Bennett Freeze. It was named after a former Commissioner of Indian Affairs, Robert Bennett. That ban remained in place for forty years, after finally being lifted in 2009. But the decades of underinvestment in the most basic of infrastructure… are very much present today.

Here’s Jamescita again:

Jamescita Peshlaki: And so, when people return home, they have to return home to hauling water, using the same wash water for multiple family members, and then also being very conservative in bathing. And so, these are things that has become a way of life for those that do not have this infrastructure. For my family, we have to drive twenty-five miles to deliver drinking water to my aunt at our family’s sheep camp.

Celine Gounder: Access to water is complicated by other factors, too. The reason Jamescita has to drive twenty-five miles to bring water to her aunt is because the well where her aunt lives is contaminated. Jamescita says toxic runoff from uranium and coal mining has left many water sources in the Navajo Nation undrinkable.

And many of the streams and rivers that would otherwise provide water to the land where the Navajo live have been diverted for other purposes, like the Hoover Dam, which provides electricity and drinking water to cities like Las Vegas.

Melissa Begay: There is this basic lack of infrastructure: 30% without water, 30% without electricity, and 30% without plumbing.

Celine Gounder: Dr. Melissa Begay again.

Melissa Begay: The lack of water definitely presents an issue in terms in sanitation. When you are trying to tell people to wash their hands, um, that presents a problem. Uh, they are often rationing their water, trying and make it last. So washing hands can’t be performed as often. And so the public health message to wash hands, uh, that’s definitely, um, problematic.

Celine Gounder: The lack of water also contributes to food deserts on the reservation. And that brings high levels of comorbidities, like obesity and diabetes, that can increase someone’s risk for severe COVID disease.

Melissa Begay: Basically, the diversion of water created a lack of agriculture that was sustainable. The Navajo diet basically was a corn, wild game. There weren’t very many carbohydrates in our diet.

Celine Gounder: Think those paleo- or ketogenic diets that are in fashion right now.

Melissa Begay: So, a lot of the traditional foods like blue corn, venison, deer. These food sources are basically made to be nonexistent. So, they were replaced by grocery stores that were basically not the best grocery stores. In 2014, a study found that a lot of these stores lacked, uh, basic fruits and vegetables, um, and basic nutritious foods. They were often high salt, high fat, high calorie food sources. And so these, uh, grocery stories basically replaced the traditional food system of Navajo

Celine Gounder: And how many such grocery stores are there on the Navajo Nation?

Melissa Begay: So, there are thirteen full service grocery stores. That’s for the entire Navajo Nation, which is basically the size of West Virginia. To have thirteen grocery stores in an area that large is definitely problematic.

Celine Gounder: And Melissa says that many of the 175,000 people who live on the Navajo Nation have to drive two hours each way to reach one of these grocery stores.

Melissa Begay: If you don’t have access to your essential supplies, such as water, such as food, you are definitely going to have to break isolation and travel to these larger cities and these border towns to get your essential supplies. And so when the Navajo Nation is, uh, imposing a curfew, it makes it very, very difficult for families.

Celine Gounder: And Jamescita says this dynamic is contributing to discrimination.

Jamescita Peshlaki: Right now we have a lot of, um, folks that are non-Native, that are, are kind of lashing out at the people because the numbers on the Navajo Nation are so high in Navajo County and Coconino County. And I see people on social media saying the Navajo should shop in their own grocery stores, and pointing at us like we’re the ones that started this and so that is really unfair. And, um, a lot of people you see on social media are blaming Asians that are, you know, Americans here blaming them. So that’s unfair.

Melissa Begay: There are a lot of border towns that remain today still politically and racially discriminatory against Navajo people. And I think a lot of tribal members today are still trying to figure out how we can, can prevent that.

Celine Gounder: Melissa Begay.

Melissa Begay: In my lifetime, I was able to witness as a young child the hantavirus outbreak that occurred in the Four Corners area in the 1990s. When they were first naming hantavirus, they wanted to call it something referencing the Four Corners or Navajo people. And a lot of the Navajo leaders did not want that because they did not want to be singled out or to be discriminated against. And so, they ended up calling hantavirus the “sin nombre” virus, which means in Spanish “no name.” And so a lot of Navajo people today are still worried about that with COVID.

Celine Gounder: Melissa and Jamescita say that despite all these challenges—the loss of traditional knowledge, generational trauma, chronic disinvestment and the health issues that follow—the pandemic is inspiring their people to take action. And traditional Navajo beliefs are a big part of that. One is the idea of balance, or hozho. Here’s Jamescita:

Jamescita Peshlaki: In the Navajo teachings, there’s always a negative and a positive. Everything in life is about balance, hozho, and even in our ceremonies, there are ceremonies for good positive things. And then there are ceremonies where we are taken off the beauty-way path, which is the path of harmony, and put on a path of what is called, anaʼí, which is “the enemy.” And right now, in the culture and traditional teachings to understand our place concerning our relation to this COVID 19, is that it is the enemy. We have to think of it as a being that is coming to each door and knocking. So, we have to think about it as an unseen monster and unseen enemy. And to defeat it, we have to come to know it. And through teaching and listening to the news, science, facts, these are the tools with which we arm ourselves and our elders and our children. The world has to have a negative and a positive. That’s life, and finding that balance now is more important than ever.

Melissa Begay: I think it’s causing a lot of Navajo people to re-embrace the concept of hozho, and I think through this positive thinking, Navajo people are going to experience a renewal of a lot of the traditional teachings, and a renewal of agriculture, farming, language, and possibly a renewal of government and public health infrastructure to actually reflect some of these cultural values of hozho.

Celine Gounder: Just like in communities across the United States, the pandemic is exposing weaknesses in public health infrastructure and the inequities of our society like never before.

Melissa Begay: I think right now, what we’re seeing is a call to action which is in place by the larger governments. But what you’re also seeing is a resilience, um, and renewal of these grassroots organizations. These grassroots organizations are getting out food, resources, water, and traditional knowledge. They’re relaying information. The positivity and the resilience that we, that we’ll see after we’re done with this pandemic. I think a lot of the Navajo leaders and Navajo people will request for, uh, this concept of hozho, to be placed in these new infrastructures that we’re going to build.

Celine Gounder: Melissa says that the elders in the Navajo community tell stories about the past epidemics their people faced. Traditionally, these lessons are passed on by elders and traditional healers. They are the repository of the tribe’s knowledge and history. Where Melissa works, the University of New Mexico Health Sciences Center, for example, they are finding ways for Navajo healers to practice their traditions alongside conventional medical care.

In a community that is so remote and struggles to get access to critical public health information, new tools like social media and smartphones have become vital to curbing the rate of infection. And that’s why Jamescita sees a change in the time of COVID. Maybe this time the key to ending the pandemic in their community will come from the young.

Jamescita Peshlaki: We’ve always looked to our elders to have teachings for us to move forward. But today, this COVID-19 it is putting a very harsh teaching in the hands of our children, where our children are the ones that are saying, ‘mom, dad, grandma, grandpa, you cannot go into town because it’s a very dangerous’. And so, um, young people are, are being handed this harsh teaching for them to, to move forward into the future. You know, when we started this interview, you asked me about what is the teachings that you’ve heard about from, from our elders and right now where we’re living through a teaching that will be that of our children and our grandchildren.

I myself still have my grandmother. She’s about 86, and she’s, she’s at home and her great grandchildren are taking care of her. And the great grandchildren are not allowed to go anywhere because they might bring something home to her. So, it’s like caring for a very, very rare flower. She’s very delicate and, and that’s how we think. I think we should all think about our elders. And so these are part of the new teachers that I mentioned, um, new ways of caring for our elders. But then I think one of the things that they know is that they are loved.

Celine Gounder: “Epidemic” is brought to you by Just Human Productions. We’re funded in part by listeners like you. We’re powered and distributed by Simplecast.

Today’s episode was produced by Zach Dyer and me. Our music is by the Blue Dot Sessions. Our interns are Sonya Bharadwa, Annabel Chen, Claire Halverson, and Julie Levey.

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And check out our sister podcast “American Diagnosis.” You can find it wherever you listen to podcasts or at americandiagnosis.fm. On “American Diagnosis,” we cover some of the biggest public health challenges affecting the nation today. In Season 1, we covered youth and mental health; in season 2, the opioid overdose crisis; and in season 3, gun violence in America.

Celine Gounder: I’m Dr. Celine Gounder. Thanks for listening to “Epidemic.”